The aim of this project is to use epidemiologic methods in a randomized clinical trial to test the effects of a psychosocial intervention to improve functional ability in elderly stroke patients. The proposed intervention is designed to mobilize the social networks of stroke patients, comprised for the most part of family and close friends, to provide effective emotional and instrumental support and increase the patient's sense of self-efficacy regarding ability to regain function. This intervention is tailored specifically to the needs of individual stroke patients, their families and support systems and is designed to occur in 15 meetings over a 6 month period. Stroke patients (n=290) from the 2 major hospitals in New Haven will be randomly allocated to the psychosocial intervention (PSI) and usual care (UC) groups. Primary endpoints are assessed at 3 and 6 months and are based on self-reports and performance-based assessments of functional ability. Several longitudinal epidemiological studies have reported that social support influences recovery of functional ability both in terms of physical functioning and psychological adjustment in stroke patients. Furthermore a number of observational cohort studies have indicated that lack of social support is related to increased mortality, especially case- fatality. Finally, several recent intervention studies have shown that psychosocial interventions have led to improved psychosocial adjustment in stroke patients and longer survival in patients with other chronic illness. Important components of these interventions have been focused on improving or providing support to patients with chronic illness and improving family functioning. To date, no interventions have focused specifically on the outcome we consider to be a critical one - improvement in physical functioning. Our aim is to employ rigorous clinical trial methodology to test the effectiveness of a psychosocial intervention to improve functioning in elderly stroke patients.